Provider Demographics
NPI:1083645022
Name:HOSPICE OF REDMOND
Entity Type:Organization
Organization Name:HOSPICE OF REDMOND
Other - Org Name:HOSPICE OF REDMOND AND SISTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEAD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:541-548-7483
Mailing Address - Street 1:732 SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-9400
Mailing Address - Country:US
Mailing Address - Phone:541-548-7483
Mailing Address - Fax:541-548-1507
Practice Address - Street 1:732 SW 23RD ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-9400
Practice Address - Country:US
Practice Address - Phone:541-548-7483
Practice Address - Fax:541-548-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR132063Medicaid
OR38*1512Medicare ID - Type UnspecifiedMEDICARE NUMBER